Wardrop, D., Estcourt, L.J., Brunskill, S.J., Doree, C., Trivella, M., Stanworth, S., & Murphy, M.F. (2013). Antifibrinolytics (lysine analogues) for the prevention of bleeding in patients with haematological disorders. The Cochrane Database of Systematic Reviews, 2013(7). 

TOTAL REFERENCES RETRIEVED: 470

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Several authors were involved in the review. The initial search was completed by one author; subsequently, two authors performed a secondary screening of identified studies. Lastly, two authors, using the Cochrane “risk of bias” tool, evaluated the remaining studies. Meta-analysis was not done given the heterogeneity of the data.

• FINAL NUMBER STUDIES INCLUDED = 3
• TOTAL PATIENTS INCLUDED IN REVIEW = 86
• KEY SAMPLE CHARACTERISTICS: Sample sizes ranged from 12 to 56 patients of all ages published in the years 1983–1995. Patients included those with APL, acute leukemia, and de novo AML. Two studies compared TXA and placebo; one compared EACA and placebo.

PHASE OF CARE: Transition phase after active treatment
 
APPLICATIONS: Pediatrics, elder care

The authors determined the evidence for efficacy (prevention of bleeding) and safety (lack of thrombosis) to be low-grade. Three studies demonstrated a reduced risk of bleeding, a reduction in platelet transfusion, and a lack of development of thromboembolism.

The findings suggest that antifibrinolytics may reduce bleeding and the need for platelet transfusions. There was no evidence for an increased risk of blood clots secondary to antifibrinolytics. Whether the antifibrinolytics reduced the need for other types of transfusions is unclear. The findings support the need for larger trials.

The small sample size was deemed to be below the optimal information size, and thus is a major limitation.

Nurses are involved in the care of patients with hematologic malignancies at risk of bleeding. It is imperative that nurses become knowledgeable regarding the use of agents that may mitigate this risk.